Health care reform: The uncivil war dividing America

Health Policy
August 31, 2009

The following is part of a series of original guest columns by the American College of Physicians.

by Steven Weinberger, MD, FACP

The unfettered debate about ideas that characterizes the democratic process in the United States operates best when there is a truthful presentation of the issues, and when the process is civil and respectful. Unfortunately, the debate about health care reform has evolved to the point that it …

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Health care reform: The uncivil war dividing America

How a wealth of information takes attention away from the patient

Patient
August 31, 2009

by Abraham Verghese, MD

This month I am the attending physician overseeing an internal medicine team, one of four such teams that admit patients to my teaching hospital. It’s a great time to be an attending physician. I have seasoned interns who in just a few weeks will be junior residents, and I have even more seasoned senior residents on their way to entering practice or entering subspecialty training. The team …

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How a wealth of information takes attention away from the patient

Health care as a futures exchange

Health Policy
August 30, 2009

by Susan H

It seems that health insurers are serving as exchange and clearing firm for “health futures” traders. Traders of “health futures” are potential patients, and health care providers. Patients are synthetic buyers of futures on health care provision, doctors and providers of medical goods and services are short sellers of those futures. The exchange and clearing firm (health insurer) represents that it serves to stand as guarantor in the …

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Health care as a futures exchange

Why following a delayed vaccine schedule may be dangerous

Conditions and Diseases
August 29, 2009

by Steve Perry, MD

I recently read a post by Dr. Bob Sears which listed several “Vaccine Friendly Doctors” in Colorado and across the nation.

As a pediatrician and vaccine advocate, I thought I’d be on this list. I am “vaccine-friendly doctor” who works with moms and dads to find the best health care plan for their babies. I read the information on both sides of the issue and weighed the science …

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Why following a delayed vaccine schedule may be dangerous

Are relationships being lost in medicine, and are hospitalists partly responsible?

Physician
August 29, 2009

An emergency physician, like me, may be the worst possible person to discuss relationships with patients. I mean, one of the reasons I chose this specialty was that I didn’t want long-term relationships with my patients. I see, now, that God has a great sense of humor.

See, the county I landed in after residency is small enough that I do know many of my patients, and I do see them …

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Are relationships being lost in medicine, and are hospitalists partly responsible?

Increasing radiation exposure to patients from CT scans and other imaging tests

Conditions and Diseases
August 28, 2009

by Kristina Fiore, Staff Writer, MedPage Today

Imaging procedures can expose patients to high cumulative doses of radiation, researchers say.

medpage-today In a large study, 193.8 people per 1,000 were exposed to moderate doses of radiation each year, while 18.6 per 1,000 were exposed to high doses, and 1.9 per 1,000 received very high doses, according to Reza Fazel, MD, of …

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Increasing radiation exposure to patients from CT scans and other imaging tests

Will medical malpractice reform be included in the final health bill?

Physician
August 27, 2009

Believe it or not, some element of federal tort reform is not only possible, but likely.

Sounds counterintuitive? We all know that Congress has a strong majority with Democrats. We know the President is also a Democrat. We know the plaintiff’s bar strongly supports the Democratic Party. We know that Democrats have traditionally shied away from specific reforms, such as caps on pain on suffering. So, this would seem the worst …

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Will medical malpractice reform be included in the final health bill?

New troponin tests to better diagnose a heart attack

Conditions and Diseases
August 27, 2009

by Crystal Phend, Senior Staff Writer, MedPage Today

A generation of new, more sensitive troponin assays has improved hospitals’ ability to diagnose a heart attack to a point as early as the time of emergency department presentation, two separate studies affirmed.

medpage-today1 In one multicenter study, a sensitive troponin I assay had an early diagnostic accuracy of 96%, compared with conventional …

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New troponin tests to better diagnose a heart attack

Drug company ethics and the pharmaceutical industry’s pursuit of profit

Medications
August 26, 2009

Ghostwritten clinical papers. Off-label marketing. Channel-stuffing. Hiding of negative data.

Pharma companies have earned a hefty percentage of the opprobrium heaped on them by a skeptical public. And it’s mainly because of a failure to heed the Golden Rule. We all know the “classical” Golden Rule: Treat others the way you’d wish to be treated. But in so many cases, drug manufacturers seem to adhere to a different version: the Gold-in …

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Drug company ethics and the pharmaceutical industry’s pursuit of profit

Is Caster Semenya a woman, and the issues surrounding androgen insensitivity syndrome

Conditions and Diseases
August 26, 2009

Caster Semenya is the South African track and field star who recently was engulfed in controversy at the recently concluded World Track and Field Championships.

caster-semenya Turns out, there are some who are questioning her gender, and subsequently, tests are being conducted to see if she is really a woman.

It’s not as cut and dry as it appears.

Consider the possibility of Read more…

Is Caster Semenya a woman, and the issues surrounding androgen insensitivity syndrome

How to make industry influence transparent in continuing medical education

Medical Education
August 25, 2009

by Larry Husten, Ph.D.

A recent hearing of the Senate Aging Committee on continuing medical education (CME) should scare anyone who might need to see a doctor in the next few years. But you don’t need to be a Washington policy wonk to discover that there’s a huge problem with CME.

Just walk into the lobby of any major downtown hotel when a large medical conference is in town and you will …

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How to make industry influence transparent in continuing medical education

Michael Jackson dead from propofol, is Dr. Conrad Murray solely to blame?

Conditions and Diseases
August 24, 2009

Recent reports have said that Michael Jackson died from a propofol overdose. Is that really the case?

Here’s what happened, according to the published timeline.

— At about 1:30 a.m., [Dr. Conrad] Murray gave Jackson 10 mg of Valium.
— At about 2 a.m., he injected Jackson with 2 mg of the anti-anxiety drug Ativan.
— At about 3 a.m., Murray then administered 2 mg of the sedative Versed.
— At about 5 …

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Michael Jackson dead from propofol, is Dr. Conrad Murray solely to blame?

Is health care a public good?

Health Policy
August 24, 2009

by Jeoffry B. Gordon, MD, MPH

The public policy and current political action around changing the system overlooks two important technical fallacies:

(1) That health care is most efficiently distributed by a free market mechanism; and,
(2) That medical services are an ordinary commodity.

The commercial market model is a failing economic and public policy ideology used to rationalize and justify corporate control of the health care system to profit from the enterprise. …

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Is health care a public good?

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Will nurses solve the primary care crisis?

Physician
August 23, 2009

by Derek Mazique

Between “death panels,” a NICE-style cost effective analysis board, and Obama’s slowly graying hair, one conspicuously absent part of reform are reimbursement rates. Medicare and private insurance typically reimburse for expensive procedures, which ultimately rewards procedure-heavy specialists while discourage those cognitive-heavy services like primary care docs.

The result? As a recent Baltimore Sun op-ed and this very blog pointed out, a combination of pay and burn-out are encouraging …

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Will nurses solve the primary care crisis?

What can John Mackey and Whole Foods learn from publicizing their views on health reform?

Health Policy
August 21, 2009

Today’s health care communications lesson is brought to you courtesy of Whole Foods … I mean John Mackey.

John Mackey’s stepped in it again. Last week, Mackey, the libertarian CEO of natural-foods behemoth Whole Foods, wrote an op-ed piece on health reform for The Wall Street Journal. But Mackey felt it necessary to republish it on his blog because the Journal editors lightly edited it, Journal headline writers wrote a …

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What can John Mackey and Whole Foods learn from publicizing their views on health reform?

Do patients really need their complete lab and radiology reports?

Conditions and Diseases
August 21, 2009

Most prefer the bottom line, sparing them the raw data.

Primary care physician Rob Lamberts asks that exact question, and reprints sample reports of lab tests and an echocardiogram, demonstrating the wealth of information they contain.

So, borrowing this image from Dr. Rob, I’m not sure how useful something like this would be to patients (sorry for the small type, but you get the idea):

lab-values

Do patients really need their complete lab and radiology reports?

A doctor in Cuba becomes a nurse in the United States

Physician
August 20, 2009

When physicians in other countries come to the United States, they often become nurses or lab technicians, rather than re-taking rigorous board exams to remain doctors.

One example includes doctors from Cuba. According to this story in The New York Times, “6,000 medical professionals, many of them physicians, have left Cuba in the last six years.” Cuban doctors, who often earn $25 per month, find it significantly more …

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A doctor in Cuba becomes a nurse in the United States

The consequences of doing everything in end-of-life-care

Physician
August 19, 2009

Fear-mongering about health care reform killing grandma really burns me: I have delivered “everything”, I know what “everything” looks like. I know its dark side. I also know that these deliberate and self-serving lies will ultimately hurt not only grandma, but the rest of us too. Here is what I mean.

When I was in practice I cared for critically ill patients. I loved the ICU for its complex physiology and …

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The consequences of doing everything in end-of-life-care

Is it fair to compare American health care with systems in Europe or Canada?

Health Policy
August 18, 2009

by Ralph Silverman, MD, FACS, FASCRS

I am tired of the comparisons people make between health care in the United States and other countries. For instance, there are those who think that we should have universal health care because some European countries and Canada do.

It is true that those countries do have universal health care, but is it a fair comparison?

Who does Canada rely on to defend its borders? When the …

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Is it fair to compare American health care with systems in Europe or Canada?

How to fix the primary care shortage

Physician
August 17, 2009

The primary care physician (PCP) shortage has attracted a lot of attention recently, and for good reason. Individual Americans are concerned that they will not have timely access to needed medical care, and policy makers are concerned that our specialist-heavy medical system is failing, giving us expensive but disjointed, poor quality care. Many experts rightly think that a robust primary care system would give us better health care for …

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How to fix the primary care shortage

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